This well-established, evidence-based men’s and youth program in BC, Canada, has helped thousands find and sustain long-term recovery.
Last Door Recovery Society, in British Columbia, Canada, has been providing addiction treatment for men and male youth for over 35 years. They offer youth and adult programs with substantial family support, and a “10 day intro to recovery” for individuals who may not be ready to commit to longer-term inpatient care but want to explore that option. More than just a rehab, Last Door is “an inclusive supportive addiction recovery community.” People come to Last Door to find recovery from drug and alcohol addiction, gambling addiction, video game addiction, internet addiction, and nicotine addiction. Last Door is located in New Westminster, a community that has become known as the Recovery Capital of Canada. Keystone, their 40-acre rural property one hour from Metro Vancouver, provides horticultural, wilderness, and recreational therapy.
One of the things that sets Last Door apart is the level of participation from their alumni as mentors and volunteers. When invited to participate in a survey for the purpose of this review, more than 90 former residents responded, from recent graduates to alumni who completed the program more than 30 years ago. The bonds formed between residents and alumni have created an unbroken chain of mutual support spanning decades.
Last Door alumni describe their fellow residents as coming from a wide range of economic backgrounds, “From homeless to professionals earning 6 or 7 figures,” with diverse histories. Some describe desperate circumstances that led them to Last Door: “I was thinking of doing an armed robbery at 7-11 to get high or go to jail.” A family member connected him with a Last Door alum and he ended up staying for seven months. Many people find their way to Last Door through referrals from former residents, who refer to themselves and others as “Door Boys.”
Last Door is well established and connected to the local community, and many clients are also referred by detox facilities, other therapeutic communities, and courts. For this reason, Last Door is the first choice for many people who live in the area. For others it is quite literally the last door: “I was in deep addiction for 35 years, went through many other treatment centres with no luck.” Said another, “A friend told me about Last Door and the success they had with him. I saw the change in him and I wanted it.” His friend, like many alumni, not only referred him, but helped facilitate the transition. The gentleman went on to describe his time at Last Door as “An amazing experience.”
Residents’ lengths of stay vary quite a bit, from a few months to a year or more. Some graduates go on to volunteer or become staff members. The youth program (13-18) is based on a “social model” which offers scaffolding in all areas to “improve overall functioning,” with the goal of improving self-esteem and decision-making skills. There is ongoing aftercare support for this group in the form of “Emerging Adult” alumni groups. One resident noted that their peers “were not excited to be in treatment at first” but after some time they became “invested in the other people there and made recovery look fun.” Another alum of the youth program reports that they “made great friends, and worked through problems with people I didn’t like.”
Alumni were enthusiastic about the food at Last Door, describing “fresh home-cooked cuisine,” “comfort food,” and “Great variety of healthy, hearty and gourmet meals from day to day” with plenty of leftovers. While nutritious options are always available, one alum recalls that “Meals weren’t always healthy but were always delicious.” Another described “calorie dense” meals “centered on making opioid addicts gain weight.” Coffee, tea, and juices are always available, as well as snacks like fruit, trail mix, chips, and babybel cheese. “Dinners were what you’d get from a really good restaurant,” with a variety of proteins, including steak or ribs on Fridays, “everything carefully made by a trained Chef.” Residents also described “out of this world potlucks” and “amazing” weekend brunches. Least favorite items mentioned were “fish” and “curry.”
Accommodations at Last Door are shared, sometimes with four people in one large room. “Relationship skills were gained,” said one alum. “I learned to get along with all kinds of people.” Chores are divided, but “everyone has a chore they must attend to twice daily, which can be anything from cleaning to helping make meals.” Daily life is structured and based around NA meetings in the mornings and evenings. There is group therapy and free time, spent “hanging out with each other,” going to the gym, and “going on outings.” As residents progress through the levels of treatment, they may transition into working an outside job.
Most alumni felt that staff were fair when it came to infractions. Misbehavior such as “smoking, aggression, poor attitudes” or “leaving the property” (without permission or notice) was handled “swiftly and evenly. No grey areas.” Depending on the severity of the transgression, discipline could include completing “written exercises,” doing “extra chores,” or having “restrictions on access to certain activities.” In extreme cases, a resident could be discharged. Generally, “the punishment fit the crime and was usually pretty fair,” and infractions were treated “diligently, respectfully, and sternly.” A few alumni complained that some staff were “unprofessional” and exhibited “favoritism.”
Amenities at Last Door include a main gym and pool about a 20-minute walk away, weekly yoga and acupuncture, music therapy, martial arts, meditation, and more. Residents are encouraged to get involved with the greater recovery community and participate in NA dances and Recovery Day. Outdoor activities include “bowling, hiking, swimming, paintball,” volley-ball, and frisbee. Keystone, Last Door’s countryside retreat facility, was described as a “fantastic break from the centre while still continuing that fantastic fellowship and the recovery,” while another alum felt that “Keystone was definitely a good experience but not always accessible to everyone and not equally distributed.” Other off-site excursions are encouraged as long as they are approved by staff.
Rules governing access to phones and the internet vary depending on the level of treatment. People in the early stages are not allowed to have their phones (or any personal money). After a set amount of time, phone use is allowed in non-group times as long as staff and other residents agree that there will be no misuse. Unsupervised emailing is not allowed, and internet access is only available at the library. TV is available on the weekends, and some alumni reported watching movies three times a week. While transitioning to working at a job, these rules are variable and determined in consultation with one’s caseworker.
A doctor is on site at Last Door once a week (as well as on call 24 hours), and there is a clinic about ten minutes away. Alumni praised the doctors as being “very helpful and compassionate,” “extremely easy to be around,” and “extremely knowledgeable in dealing with addicts specifically.”
According to the alumni who took our survey, Last Door is a 12-step- and social model-based program, and not centered around religion, although “anyone was free to practice whatever religion they believed in.” The treatment is “very strict in terms of having to follow the rules and participate” and “very much a ‘tough-love’ approach in that they did not coddle us or baby us.” However, “the counsellors and staff were also very supportive, patient and empathetic.”
Since leaving Last Door, the majority of the respondents who took our survey have remained clean, sober, and/or abstinent, with one “coming up on 30 years.” Some have relapsed and come back, crediting Last Door with providing “a deep recovery foundation.” Many have stuck around, volunteering at Last Door after finishing treatment. “You feel like you are part of a family,” one alum said, describing the “supportive camaraderie” that ensures “nobody gets left behind.” In fact, after completing treatment, you keep your facility key so “you can come and go as you like, if you want to drop by to have lunch, attend a group session or just visit and hang with the new guys.”
When asked what Last Door could do better, most alumni felt that Last Door was already “the most effective treatment centre,” or that they should “add more beds.” Some respondents, however, felt there should be more “awareness on mental health” and a better “platform for mental illness treatment,” with “mental health evaluations when you enter treatment” and counselors with “better credentials.”
Overwhelmingly, the alumni who took our survey had high praise for their entire experience at Last Door. Describing the group therapy sessions, one alum recalls “An incredible amount of recovery, healing, tears and growth took place during nearly every group session.” Another resident is grateful for forming “genuine connections with people. And learning to love myself.” One former resident describes “ feeling a sense of belonging and connection for the first time in so long. Having a strong recovery community of men who support each other was something I’ve never had before.” One alum echoed many others’ feelings with this final thought: “A part of me will always be there.. and for that I am forever grateful.”